Provider Demographics
NPI:1104800606
Name:TESTANI, MATTHEW ANGELO (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ANGELO
Last Name:TESTANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:FL 2
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:
Practice Address - Street 1:4433 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-772-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005724213E00000X
NY005943213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011975760003Medicaid
PA1011975760004Medicaid
PA1011975760001Medicaid
PA1011975760002Medicaid
PA1011975760004Medicaid
PA088529Medicare ID - Type Unspecified
PA1011975760003Medicaid
PA1149270001Medicare ID - Type UnspecifiedNHIC DME-BIGLERVILLE SITE
V04020Medicare UPIN
PA1149270002Medicare ID - Type UnspecifiedNHIC DME-DILLSBURG SITE